Fertility isn’t always immediately on someone’s mind when they are first diagnosed with cancer. But for some, problems with fertility — in time — can become more of an issue.
Many reproductive-age men and women in the United States successfully undergo cancer treatment each year, and many of those men and women have a desire to start a family.
|UAB’s Fertility Preservation Program, led by director Wright Bates offers treatments for fertility preservation for individuals or couples interested in having children who face cancer or other serious medical conditions.
UAB’s Fertility Preservation Program, directed by Wright Bates, M.D., offers advanced treatments for fertility preservation and restoration for individuals and couples who have cancer or other serious medical conditions that may affect their chances of having children.
The UAB Division of Reproductive Endocrinology and Infertility is part of the National Institutes of Health-sponsored Oncofertility Consortium, a national in-terdisciplinary initiative to explore reproductive options for patients diagnosed with serious diseases. The aim of the consortium, which is based at Northwestern University, is to increase awareness of and advance the science of fertility preservation. UAB is one of the first institutions with Institutional Review Board approval for tissue-banking in conjunction with the Oncofertility Consortium.
“The goal is to increase our understanding of the impact of cancer treatment on reproduction. We need the answers to basic questions such as how likely is a man or woman to become infertile after cancer treatment,” Bates says. “You’d think that’s something we readily know, and we don’t. We can only make broad estimates based on a woman’s or a man’s age, type of cancer and duration or dose of chemotherapy and the amount of radiation exposure they receive”.
“We’re trying to define how often reproduction and fertility are affected by chemotherapy or radiation and develop techniques to combat that.”
The Health Services Foundation recently awarded the program a grant to raise awareness of the potential for fertility preservation in Alabama.
Nationwide, less than 1 percent of women are sent to fertility doctors for consultation, and only about 10 percent of men are offered sperm-banking prior to cancer treatment. UAB is beginning a large outreach campaign this fall to increase awareness among medical professionals and the public about the options available.
“Evidence shows that those who at least discuss fertility treatment options with a specialist cope better with their cancer treatment whether they choose to pursue fertility treatment or not,” Bates says.
“Many options are available for those who choose to pursue fertility preservation.”
Preserving fertility in women
Advanced techniques are being used to give women with cancer viable options to preserve their fertility before their treatment, including:
• In vitro fertilization (IVF) and embryo freezing
• IVF and egg freezing
• Ovarian tissue freezing
• Ovarian transposition or relocation
Currently the only recommended and approved option is IVF with embryo freezing. Egg freezing and ovarian tissue freezing are considered experimental, and both are being developed at UAB Hospital in collaboration with the Oncofertility consortium.
“There are tens of thousands of children born as a result of embryo-freezing; it is the most established and has the highest success.” Bates says. “Hundreds, maybe thousands, of children have been born after egg-freezing. Because it is a very new technique, there have been just a few dozen children born after ovarian-freezing.”
So why freeze the ovaries? It has the potential to be a much more attractive option over embryo freezing for several reasons. Embryo freezing requires time to get the woman ready to harvest her eggs, and she needs a spouse or partner to fertilize the egg. In most cases the woman also has to take hormones, which may raise her hormone level and may impact her cancer treatment. Ovarian tissue freezing requires no hormone treatments and little or no delay.
With ovarian tissue freezing the tissue may be stored for years and re-implanted with the potential added benefit of restoration of normal hormone production by the ovary.
“And with ovarian freezing, if someone calls today, in theory we can do it tomorrow,” Bates says. “There’s no prep time, and it’s outpatient surgery.”
UAB surgeons also can harvest most or all of one ovary, divide it and freeze it in strips and re-insert it back in the remaining good ovary when cancer treatment is done.
“That gives the patient the potential for a successful pregnancy without fertility treatment,” Bates says. “And unlike the other treatments, it’s the only one that has the potential to restore normal hormone function. That may mean fewer hot flashes, better sleep and better sexual function.”
Surgery, storage of the tissue and insurance coverage are disadvantages to freezing ovarian tissue.
“It can be costly because you have a surgery to harvest, you have freezing for years if not decades, and then you have surgery to re-insert or auto transplant the tissue,” Bates says. “Insurance covered our past two cases, but it’s very much a case-by-case, company-by-company decision.”
The other drawback is the potential for ma-lignant cancer cells in the harvested ovary. A harvested ovary is tested for cancer prior to freezing. If it’s free of cancer the freezing process can continue. No cases of cancer reoccurrence as a result of ovarian tissue re-implantation have been reported.
Preserving fertility in men
UAB’s fertility preservation program offers sperm-banking for men. Samples can be stored for several years and used for insemination or IVF with intra-cytoplasmic sperm injection.
Semen samples may be frozen prior to the start of chemotherapy or radiation. In some cases, artificial or intrauterine insemination (IUI) may be performed when the couple is ready to pursue fertility. In many instances, IVF with injection of the sperm into the egg is required because of low number and poor quality of the sperm.
Help after treatment
Many women and men are able to safely pursue pregnancy after chemotherapy or radiation, and Bates says there is help available at UAB.
“We commonly see patients who have had treatment, and it’s relatively easy to restore normal, healthy hormone levels with supplementation,” Bates says. “We also offer assisted reproduction with donor sperm or egg so those couples can experience a pregnancy and become a parent.”
UAB’s reproductive experts work with a patient’s oncologist to determine fertility potential and treatment options. For men, sperm production and function may take several years to recover. A semen analysis is used to determine the potential for pregnancy, with several options available based on test results. A woman’s fertility potential may be determined with a blood test and ultrasound of the ovaries. The full range of reproductive options then will be reviewed.
“Many patients will in fact have some return of function, and that’s based on a combination of the type of treatment they had, the type of cancer they had and the age they experienced it,” Bates says.
UAB’s IRB approval for fertility preservation ranges from ages 8 to 40. Visit www.uabmedicine.org/fertilitypreservation for more information or call 801-7623.